右肺下叶肿块1例

2018-07-17 佚名 影像园

患者入院前半月无明显诱因出现咳嗽、咳痰,无胸痛、胸闷、呼吸困难。就诊于当地医院,诊断为肺部感染,对症给予抗炎、镇咳等治疗后患者症状略好转。3天前发现痰中带血,就诊于当地医院,行肺部CT发现右肺阴影,不排除肺癌。

【所属科室】

呼吸科

【基本资料】

患者,男,70岁

【主诉】

咳嗽半月,伴咳血3天

【现病史】

患者入院前半月无明显诱因出现咳嗽、咳痰,无胸痛、胸闷、呼吸困难。就诊于当地医院,诊断为肺部感染,对症给予抗炎、镇咳等治疗后患者症状略好转。3天前发现痰中带血,就诊于当地医院,行肺部CT发现右肺阴影,不排除肺癌

【影像图片】









































【讨论问题】


【讨论】

评论:右肺下叶软组织密度肿块影,下叶支气管闭塞,多发血管被包绕。

【结果】

病理诊断:(右下肺开口肿物)鳞癌。

【病例小结】

中央型肺癌发生在主支气管、肺叶支气管和肺段支气管。生长类型可分成管外型、管壁型、管内型,其中以管外型为主,以腺癌、鳞癌等为主要病理类型。肿瘤的病理形态包括支气管管壁增厚、管腔内肿物和支气管周围肿块。肿瘤的生长使支气管狭窄或阻塞,可引起阻塞性肺气肿、阻塞性肺炎及阻塞性肺不张,即所谓三阻征象。

X线特征如下:

1 早期X线检查不存在异常表现。

2 伴随患者病情进展,肺门部位可见突向肺野、边缘清晰的肿块影。3 肿瘤组织若阻塞气管可产生典型“三阻征”影像学表现,即阻塞性肺气肿、阻塞性肺炎、阻塞性肺不张,其中以阻塞性肺不张最为常见。阻塞性肺炎——肿瘤阻塞气道时,相应肺段、肺叶区域有模糊索条状片状或索条状影,密度均匀。阻塞性肺气肿——若肺叶体积明显增大,肺纹理较稀疏,透明度较高,横膈、纵膈可受压而移位。肺不张——若气管彻底阻塞,可产生片状肺不张阴影。

4 伴发肺门淋巴结肿大,其下缘有倒“S”状影,即中央型肺癌,是右上叶中央型肺癌典型征象。

CT特征如下:

1 早期CT检查可见其管壁有轻度增厚情况,且管腔中有小结节、管腔阻塞或狭窄;中期、晚期的中央型肺癌患者直接征象为支气管阻塞、狭窄、肺门肿块,以支气管狭窄最为明显,表现为管腔内缘光滑或者不规则,管壁增厚;其中,支气管阻塞的主要表现为管腔变细后阻塞,管腔骤然截断;肺门肿块的主要CT表现为肺门区域外缘光滑,或者出现分叶状软组织肿块影:中央型肺癌间接征象是肿瘤未完全梗阻支气管时所致阻塞性肺气肿,肿瘤彻底阻塞支气管时,其相应部位有阻塞性肺不张、阻塞性肺炎等表现,CT表现为斑片状的模糊影,或者肺叶、肺段实变影;增强扫描后,在明显强化不张肺叶的衬托下,其狭窄支气管会显示的更清楚。

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    2019-02-17 zywlvao
  2. [GetPortalCommentsPageByObjectIdResponse(id=1763731, encodeId=57041e6373156, content=<a href='/topic/show?id=049c38666e4' target=_blank style='color:#2F92EE;'>#右肺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38666, encryptionId=049c38666e4, topicName=右肺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=adbf37558552, createdName=zywlvao, createdTime=Sun Feb 17 16:57:00 CST 2019, time=2019-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412023, encodeId=fc43141202315, content=<a href='/topic/show?id=951b82e63ff' target=_blank style='color:#2F92EE;'>#肿块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82763, encryptionId=951b82e63ff, topicName=肿块)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c58f2824468, createdName=cnxcy, createdTime=Thu Jul 19 03:57:00 CST 2018, time=2018-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332264, encodeId=ae9c33226416, content=了解一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Tue Jul 17 18:52:54 CST 2018, time=2018-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332243, encodeId=891f3322439f, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Tue Jul 17 13:12:15 CST 2018, time=2018-07-17, status=1, ipAttribution=)]
    2018-07-19 cnxcy
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    2018-07-17 天地飞扬

    了解一下谢谢分享

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1763731, encodeId=57041e6373156, content=<a href='/topic/show?id=049c38666e4' target=_blank style='color:#2F92EE;'>#右肺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38666, encryptionId=049c38666e4, topicName=右肺)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=adbf37558552, createdName=zywlvao, createdTime=Sun Feb 17 16:57:00 CST 2019, time=2019-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1412023, encodeId=fc43141202315, content=<a href='/topic/show?id=951b82e63ff' target=_blank style='color:#2F92EE;'>#肿块#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82763, encryptionId=951b82e63ff, topicName=肿块)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c58f2824468, createdName=cnxcy, createdTime=Thu Jul 19 03:57:00 CST 2018, time=2018-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332264, encodeId=ae9c33226416, content=了解一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Tue Jul 17 18:52:54 CST 2018, time=2018-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=332243, encodeId=891f3322439f, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Tue Jul 17 13:12:15 CST 2018, time=2018-07-17, status=1, ipAttribution=)]
    2018-07-17 一天没事干

    很好的学习机会

    0

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